Saturday, November 08, 2008

i am not special

the state hospital was supposed to get a surgeon. all indications were that he was supposed to start on the first of the month. the medical officers booked elective cases for him to do with excitement and anticipation. the first of the month came and the first of the month went, but no surgeon turned up. the poor medical officers now had the nasty problem of having a whole bunch of people needing operations with no one to operate them. they phoned me.

i could not do all the operations. not even close. but i told them that i would try to make myself available on tuesday afternoons. they just needed to book the most critical cases and i would do them. they organised a typical state thyroid for the first tuesday. (not quite as bad as all that but still bad)

the monday before i was on call. a pretty hectic gunshot wound came in late that night. at the same time an appendix patient also arrived. i called the anaesthetist out and we got to work on the gunshot guy. a splenectomy, distal pancreatectomy, nefrectomy and liver repair later we delivered him to icu in a surprising good state. (there was not only a great deal of blood on the part of the patient but also a goodly amount of sweat and tears on the part of all of us). we finished at about three o'clock in the morning. everyone was tired and irritable. then i suggested we do the appendix. truth be told, i was laughed at.

i considered my position. it was reasonable to postpone to the morning when i would be at least slightly rested. there would be a smaller chance of cutting something i should rather not cut. but i knew i had a full day in the rooms with consultations and scopes. thereafter i was supposed to go to the state hospital. if i left the appendix for daytime, it would clash with that appointment in all likelihood. so i simply refused to take no for an answer. i pretty much insisted that we do it there and then. all concerned finally succumbed and the appendix was removed some time after three o clock in the morning.

after a deep two hours sleep my day began in all earnest. i spent the morning in consultation and doing gastroscopies and colonoscopies. i only just finished to rush off to the state hospital to be there at two pm as had been arranged.

when i entered theater, the anaesthetist casually told me they had a child who had a foreign body stuck in the esophagus that they were going to do before my case. i was annoyed, but i knew that in state hospitals you must learn to go with the flow. otherwise constant frustration will kill you or drive you to drink.

sure enough they put the little kid to sleep and for expediency i took the thing out myself. still the anaesthetic and the usual state delay had lost us a full hour.

finally the thyroid was doped and we got under way. true to form they had booked me a monster. it was the sort of thyroid that was so big you feel you need to take it out as fast as possible because it's bullying all the other thyroids in the ward. to be honest i struggled. it was all the way up to the skull, all the way down behind the sternum and around the back to behind the esophagus. it was stressful surgery. i was trying to get it out of that neck but i swear it was trying to pull me in to devour me.

during all this, the sister who was obviously annoyed at the slow pace of the operation started berating the medical officer for starting a case that wouldn't finish before four, the time in the state hospital when all elective cases are supposed to stop. i piped in that an emergency case had been pushed in before us and therefore they owed us another hour so we were therefore still within time constraints. she looked at me."these rules are for everyone. you are not special!" and just to make sure there was no misunderstanding, she repeated,"you are not special!"

i joked about it at the time saying my mother had always told me i am, but i could feel irritation welling up. i needed to finish the task at hand so i took my mind off the comment and returned it to the thyroid which i think had just tried to bite me.

when i got home, fairly tired from work and lack of sleep and put together the entire sequence of events, including me depriving myself of sleep in order to be able to go and help at the state hospital, i became angry. it had nothing to do with if i thought i was special, but rather to do with what other options that patient had of being operated. the answer is simply none. if i didn't do it there was no one else who was going to step in and do it. then despite pretty much standing on my head in order to be available and still getting knocked back an hour on the list the sister tells me i'm not special because she has to stand 20 minutes longer than she was expecting to. i became mad with rage. i considered phoning the super and telling him to stuff his hospital and theater staff and that i was no longer willing to help.

then i thought of all the doctors there trying their best beyond their abilities to at least provide some service. slowly the rage dissipated. then the anger subsided. then i slept.

I seem to remember Laziness, being a terminal illness in South Africa, and the sister just needed her daily dose of Days of Our Lives. Perhaps to any future ignorant questions as to whether you intend to specialize, simply state quite truthfully that you are extremely special already.

There's nothing that makes my blood boil more than a seestah who, for some numbskulled reason, believes she's working because you're forcing her to and not because the patient needs her to. Those sisters are a disgrace - they're lazy and don't care about patients, and don't deserve to occupy the positions they do.

Unbelievable that whether you are in South Africa or in New York, the OR nurses are all the same--all staring at the clocks waiting to go home. I was recently thrilled, and beyond surprised, when one nurse *elected* to stay an extra 35 minutes with me to finish my last case. That has never happened before.

And yes, your mother was right (and DAMN, what a great comeback!!) you ARE special.

Anybody doing what you do is special, so there ya go. You had me laugh out loud at the thyroid bullying all the other thyroids on the ward...LOL!! I get squeamish just THINKING about all the structures there in a normal case, much less when the anatomy is whacked with dz.

The nurse thing needs to be seen for what it is--a momentary event from a (her) limited POV. Good that you moved on.

Shooo man, hav sum rooibos chai tea,lol! Mpumalanga is reali in bad shape possibly worse than Limpopo.Read u guys got the worst end of ths 2yrs internship issh. I imagine next yr might be beta wit the influx of COSMO's u missed out on last year. Lol, nursing stuff cn sumtimes be annoyin and right down rude. The theater go slows they pull 5hrs b4 knock of tym is jus spastic. Dr skakhi has their behaviour down to a T. Next tym tell her 2 cry u a river or alternatively ask her if she mind finishing up as she thinks she'l do it more efficiently.

Ugh. This reminds me of when I was working in the ICU and a patient started to crash. We desperately needed to know what drugs the nurse had just pushed. She was no where to be found. I asked her peer if she knew where she was, and explained that the patient was about to code and we needed her help. The nurse said, "She's on break. Union rules." I said, "Well couldn't she just tell us what she gave the patient and take a break after that?"

"No."

The patient coded and eventually died. I don't know if a conversation with her nurse might have helped. But I was infuriated at the callousness.

I long for the good ol' days when nurses are easily replaced. My father would have booted her off the hospital and replaced her with a new one in 2 seconds. Not only that, he would have berated the head nurse for ever employing a nurse who dare to berate ANYBODY during a surgery!

Did you know that even the darkest of darkness cannot swallow a beacon of light. Despite the environment you are in, i think u are using your skills 2 the benefit of others like a light on a hill giving hope 2 those in desperate need. I must say, rural medicine is trully a calling. U r mos def special

I know it's going back a coupla decades, but if a nurse or sister had ever spoken to a surgeon like that & in a theatre, she would've been turfed out faster than you could have muttered "scalpel"! You are special.

Hmm I seem to sense a certain amout of dislike and disrespect for theatre nurses from both you, Bongi, and several of the comments.

Whilst in no way disagreeing that your nurse really did step out of line with that comment, can I please provide you with some perspective of what it is like for theatre nurses?

You may have a case that runs late - it may be the third or fourth or fifth time that week that your nurse has been off late. And as late as you leave, she'll be leaving later because she has to clean up after the case. She probably also has been working during the morning, rather than just that case that you're doing there. She may even be pulling a double shift - not unusual in some places these days.

You admit yourself that you were tired and upset after the case - do you think maybe that you may have over-reacted? Was your reaction to her in excess of what you would normally do if you were rested? Could it be that her comment was a somewhat less than tactful way of letting you, the 'new guy', know what the rules are?

Many OR nurses will go the extra mile (or further) for their patients. How well can you do your job without them? How many times have you thanked one that did go the extra yards?

Respect is a two way street. Respect the nurses, develop a rapport with them, treat them as you would prefer to be treated, and you may be surprised. I have known many OR nurses over the years that would perform miracles for surgeons who respected them and treated them as valued colleagues rather than despised underlings.

Julie, although there are many surgeons who are disrespectful to nurses, Bongi is definately not one of them. I don't know anyone who is more respectful and nicer to them, in fact.

For that nurse to treat him like that under those circumstances is unacceptable and that is the point here.

Even if she had to stay a little later than him that day, or worked the morning or even if she had worked a double shift, which is unlikely, he works much, much longer hours. So if you're trying to gain sympathy for the hours that a nurse must work, your preaching to the wrong audience. Although he happened to go home after that case on that day, he would normally have to go straight back to work again, usually until the next morning or afternoon even. We've all done it. We know long hours, so that's no excuse.

And being disrespectful to someone who is new is also no excuse.

If anything, I think Bongi under reacted in this situation.

And if we're going to talk about perspectives, maybe we should talk about the most important perspective of all, the patient's. That's why we're all in this isn't it? Or should be. Imagine that patient's point of view: they finally get the operation they so desperately need and all their nurse is worried about is that she might have to stay at work a little bit later.

The negative comments here come from the fact that we've all experienced situations like this commonly and it's frustrating.

julie you sense wrong. i get on famously with almost all the theater sisters i have ever worked with we share a mutual respect for each other for our relevant roles in patient care. i always thank them after every theater list (including the day in question actually). also i did not over react. i did not react at all, other than making a light hearted joke at her comment. in fact, unless she reads this post she will have no idea that it upset me at all. also i am not the new guy there. i used to be head of the department of surgery there for a short while and have been a pretty regular surgeon there for two years.

i have only ever raised my voice in theater twice. once at blind chicken boy (http://other-things-amanzi.blogspot.com/2008/02/blind-chicken-boy.html) for unimaginable stupidity which ensured that the sister's sterile field was no longer sterile and once at my assistant for raising his voice at the sister.

she is no cow and usually not lazy. she however is a product of state medicine and patient service delivery is no longer high up on her list of priorities.

who knows, maybe she was having a bad day. it is all fairly irrelevant because nothing came of it, except this post.

Bongi, in that case I may have reacted badly to what I perceived as nurse-bashing by some of the other bloggers. I'm no longer in the business but I did spend >20 years, and in that time you see a lot, and some surgeons (and anesthetists) are real pieces of work. It has also made me somewhat sensitive to negative comments, particurly when you work your bum off for the hospital / doctors / patients and usually don't even get a 'thank you'.

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.